| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
547 |
138 |
$81K |
| D0330 |
Panoramic radiographic image |
424 |
423 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
378 |
377 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
123 |
$6K |
| D0272 |
Bitewings - two radiographic images |
238 |
238 |
$5K |
| D9110 |
|
77 |
75 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$931.02 |
| D0220 |
Intraoral - periapical first radiographic image |
23 |
23 |
$242.00 |